Declaration of Indemnity

'I have read the Supplementary Regulations issued for this event and agree to be bound by them and by the General Regulations of The Royal Automobile Club Motor Sports Association Limited. In consideration of the acceptance of this entry and of my being permitted to take part in this event, in respect of any parts of the event not held on a publicly adopted road, I agree to save harmless and keep indemnified The Royal Automobile Club Motor Sports Association Limited, such Person, Persons or Body as may be authorised by The Royal Automobile Club Motor Sports Association Limited to promote or organise this event and their respective Officials, Servants, Representatives, Agents and Sponsors together with other Competitors and their respective Servants, Representatives, Agents and Sponsors, from and against all actions, claims, costs, expenses and demands in respect of Death of or Injury to or Damage to the Property of myself, my Driver(s), Passenger(s), Mechanic(s) or associated personnel, arising out of or in connection with this entry or my taking part in this event'.

State your age if you are under 18 ............................

I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN which has, following such declaration issued a licence which permits me to do so.

Signatures Age if under 18

Entrant ………………………………………….. ……………………

Driver ........................................................... .............................

Passenger ........................................................... .............................

Date: ..........................................................

If a competitor is under 18 years of age this form MUST be countersigned by an appropriate parent or legal guardian.

This entry is made with my consent

For Driver For Passenger

Full name ..........................................…….. ...................................................…...

Block Letters Please

Relationship ..........................................…….. ...................................................…...

Address ..........................................…….. ...................................................…...

Tel No ..........................................…….. ...................................................…...

Signature ..........................................…….. ...................................................…...